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by Robert Preidt

Airport Screening in West Africa Will Curb Ebola's Spread: Study

Testing would-be passengers in Guinea, Liberia and Sierra Leone could spot 3 cases of disease a month
MONDAY, Oct. 20, 2014 (HealthDay News) -- If passengers weren't screened before they boarded airplanes in the Ebola-affected countries of Guinea, Liberia and Sierra Leone, three people infected with Ebola would leave on international flights from any of those West African nations every month, a new analysis predicts.
The three countries are those hit hardest by the current Ebola outbreak. Screening is currently in place at international airports in cities there, and the study results highlight the need to maintain it, according to a team led by Dr. Kamran Khan, of St. Michael's Hospital in Toronto.
In the study, the researchers analyzed airline flight schedules and passenger destinations, along with Ebola infection data, to determine how effective air travel restrictions and airport departure and arrival screenings are in helping control the spread of Ebola.
In the current situation, about three people infected with Ebola would board international flights every month from Guinea, Liberia and/or Sierra Leone if there was no screening of passengers before they departed those countries, Khan's team reported Oct. 20 in The Lancet.
"The risk of international spread could increase significantly if the outbreak in West Africa persists and grows. Risks to the global community would further increase if Ebola virus were to spread to and within other countries with weak public health systems," Khan said in a journal news release.
It's far more efficient and less disruptive to screen airline passengers for Ebola when they leave West Africa than to screen them when they arrive at airports around the world, the researchers added.
"Exit screening at the three international airports [Conakry, Monrovia and Freetown] in Guinea, Liberia and Sierra Leone should allow all travelers at highest risk of exposure to Ebola to be assessed with greater efficiency compared with entry screening the same passengers as they arrive in cities around the world," Khan said. "However, this will require international support to effectively implement and maintain."
The researchers also noted that more than 60 percent of people flying out of Guinea, Liberia and Sierra Leone this year are expected to have final destinations in less-developed nations.
"Given that these countries have limited medical and public health resources, they may have difficulty quickly identifying and effectively responding to imported Ebola cases," Khan said.
However, even though screening airline passengers before they leave the three West African countries is useful, it's only one measure and does have downsides, he added.
"The best approach to minimize risks to the global community is to control the epidemic at its source," Khan said. "While screening travelers arriving at airports outside of West Africa may offer a sense of security, this would have at best marginal benefits, and could draw valuable resources away from more effective public health interventions."
Some in the United States have called for a ban on air travel from Ebola-affected countries. But Khan believes that more "excessive constraints on air travel could have severe economic consequences that could destabilize the region and possibly disrupt critical supplies of essential health and humanitarian services."
The Ebola outbreak in West Africa has killed nearly 4,500 people out of an estimated 9,000 reported cases, according to the World Health Organization.
More information
The U.S. Centers for Disease Control and Prevention has more about the Ebola outbreak in West Africa (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html ).
SOURCE: The Lancet, news release, Oct. 20, 2014
by Robert Preidt

CDC Tightens Rules on Caring for Ebola Patients

Full body suits, respirators now recommended, along with monitor to observe workers removing gear
MONDAY, Oct. 20, 2014 (HealthDay News) -- U.S. health officials on Monday officially tightened guidelines for health workers treating Ebola patients, now requiring full body suits with no skin exposure and use of a respirator at all times.
The U.S. Centers for Disease Control and Prevention decided to issue the tougher rules after two Dallas nurses contracted Ebola while caring for the first patient diagnosed in the United States, Liberian national Thomas Eric Duncan. Nina Pham is currently being treated for her infection at the Clinical Center at the U.S. National Institutes of Health in Bethesda, Md., while Amber Vinson is being treated at Emory University Hospital in Atlanta.
Those nurses, who are employees at Texas Health Presbyterian Hospital in Dallas, had been following Ebola guidelines that the CDC first issued in 2008 and updated this August, CDC Director Tom Frieden said during a Monday evening news briefing.
"The hospital caring for the first patient, Mr. Duncan, relied on these guidelines. Two health care workers became infected. This is unacceptable," Frieden said. "We may never know exactly how that happened, but the bottom line is the guidelines didn't work for that hospital."
The enhanced guidelines issued Monday, which are intended to create an "increased margin of safety," call for heavy training in the use of protective equipment; suits that cover the entire body; and designated monitors to ensure gear is worn and removed properly.
The CDC now recommends a very specific set of gear to be worn by health care workers treating Ebola patients, which includes:
Double gloves, Waterproof boot covers that go to at least mid-calf, Single-use waterproof or water-resistant gowns that extend to mid-calf, Single-use full-face shields that are disposable, Surgical hoods to ensure complete coverage of the head and neck, Waterproof apron that covers the torso down to the mid-calf if the patient is vomiting or experiencing diarrhea, Use of a respirator at all times -- either an N95 respirator or a powered air purifying respirator.
Health care workers must undergo rigorous and repeated training in donning and doffing all this gear, until it becomes "ritualized," Frieden said.
The CDC also now recommends that hospitals have a trained monitor to observe workers as they are putting on and taking off the suits, as well as when they are caring for patients.
Hospitals also need to designate areas for putting on and taking off equipment, with enough space to allow for clear separation between clean and potentially contaminated areas, a CDC fact sheet said.
"While a lot of attention has been paid to the equipment, the greatest risk in Ebola care is in taking off whatever equipment the health care worker has on," Frieden said.
The guidance issued by the CDC represents a consensus from experts in dealing with Ebola, including health care workers at Emory University Hospital in Atlanta, Nebraska Medical Center in Omaha and the NIH. The Atlanta and Omaha hospitals have treated Ebola patients in recent weeks.
Frieden said the stricter guidelines are needed because the experience in Dallas has shown that U.S. health care workers face different challenges than health care professionals working in West Africa, scene of the worst Ebola outbreak in history.
"The way care is given in this country is riskier than in Africa," Frieden said. "There's more hands-on nursing care, and there are more high-risk procedures, such as intubation."
The Ebola outbreak in West Africa has killed nearly 4,500 people out of an estimated 9,000 reported cases, according to the World Health Organization.
More information
Visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/vhf/ebola/ ) for more on Ebola.
SOURCE: Oct. 20, 2013, news conference with Tom Frieden, M.D., director, U.S. Centers for Disease Control and Prevention
by Robert Preidt

Traffic Pollution May Be a Risk While Pregnant

Reduced lung function seen in children at age 4, study says
TUESDAY, Oct. 21, 2014 (HealthDay News) -- Children of mothers exposed to high levels of traffic air pollution during pregnancy may be at increased risk for lung damage, according to a new study.
Researchers tested the lung function of 620 children in Spain when they were 4 years old. Their mothers' exposure to the traffic air pollutants nitrogen dioxide and benzene during the second trimester of pregnancy was also assessed.
Compared to children born to mothers exposed to less traffic air pollution, the risk of impaired lung function was 22 percent higher in youngsters of mothers exposed to high levels of benzene and 30 percent higher in children whose mothers were exposed to high levels of nitrogen dioxide.
The link between exposure to high levels of traffic air pollution during pregnancy and lung damage was strongest among poorer children and those with allergies.
There was no significant evidence of a connection between exposure to air pollution in the first year of life and a child's risk of impaired lung function at preschool age, according to the study published Oct. 20 in the journal Thorax.
The findings suggest, but don't prove, that exposure to traffic-related air pollutants during the prenatal period could adversely impact the developing lung, Dr. Eva Morales, of the Center for Research in Environmental Epidemiology in Spain, and colleagues wrote.
"Public policies to reduce exposure to traffic-related air pollution may avoid harmful effects on lung development and function with substantial public health benefits," the researchers said in a journal news release.
The study offers convincing evidence that exposure to pollution before birth has long-term effects on children's lungs, Dr. Peter Sly, professor at the Queensland Children's Medical Research Institute at the University of Queensland, Australia, wrote in an accompanying editorial.
These and similar findings show policy makers that "limiting exposure to traffic-related pollution during fetal development and early postnatal life is one way that the burden of respiratory disease can be decreased," he said.
More information
The March of Dimes has more about environmental risks and pregnancy (http://www.marchofdimes.org/pregnancy/environmental-risks-and-pregnancy.aspx ).
SOURCE: Thorax, news release, Oct. 20, 2014
by Robert Preidt

Black Women Fare Worse With Fertility Treatments, Study Says

Success rates for in vitro fertilization were half those of white women
TUESDAY, Oct. 21, 2014 (HealthDay News) -- Black women undergoing in vitro fertilization (IVF) are only about half as likely as white women to become pregnant using the popular assisted reproduction technique, new research indicates, and the racial disparity persists even when donor eggs are used.
In the study, about 31 percent of white patients became pregnant after IVF, compared to about 17 percent of black patients.
Analyzing more than 4,000 IVF cycles over two years to tease out the impact of race, scientists from University of Chicago also found that miscarriage after IVF -- where eggs and sperm are joined in a lab and implanted in the woman's uterus -- occurred twice as often among blacks than whites.
These racial differences remained even though the researchers controlled for factors affecting pregnancy such as age, body-mass index (BMI, a measurement of weight vs. height), hormone levels and smoking. Asian women also experienced somewhat lower live birth rates than whites after IVF, but rates among Hispanic women were comparable to whites.
"We were just struck by these outcomes," said study author Dr. Eve Feinberg, an assistant clinical professor at University of Chicago Medical Center and a physician at Fertility Centers of Illinois. "They had been reported previously in other studies, but our study, which is quite large, really confirmed those other findings."
The study was presented Monday at the American Society for Reproductive Medicine (ASRM) annual meeting in Honolulu. Research presented at scientific meetings typically has not been published or peer-reviewed and results are considered preliminary.
Used in the United States since 1981, IVF is one of the most common forms of assisted reproduction. About 65,000 babies were born in the United States in 2012 through 176,000 assisted reproduction cycles, typically costing upwards of $10,000 apiece, according to the U.S. Centers for Disease Control and Prevention.
In another study being presented at the ASRM meeting, researchers from Columbia University Medical Center in New York found that racial differences for IVF success persisted between white and black women even when donor eggs were used.
In that research, led by Dr. Lisa Carey Grossman, uterine conditions such as fibroids or prior cesarean surgery were taken into account. Because black women have higher incidences of such conditions, the scientists compared black and white egg donor recipients who had similar uterine histories.
Despite that, black women still experienced significantly lower embryo implantation rates than whites -- 30.4 percent compared to 36.3 percent, Grossman said.
Dr. Edward Illions, a reproductive endocrinologist at Montefiore Medical Center in Hartsdale, N.Y., who wasn't involved in the new research, said he has observed the same racial disparities in IVF outcomes in his own practice.
"I'm not actually surprised, because the [medical] literature before this almost uniformly has shown a lower success rate in African-American women compared to Caucasians," said Illions, also an associate professor of clinical obstetrics, gynecology and women's health at Montefiore Institute for Reproductive Medicine.
"In most of the studies also, the BMIs of African-American women have been dramatically higher," he added. "We know from lots of data that women with higher BMIs have worse IVF outcomes, even with donor eggs."
Illions said scientists aren't yet sure why higher BMI is linked to lower IVF success. "It has to do with uterine receptivity," he said, but he added that the exact cause hasn't been pinpointed.
The experts agreed that more large-scale research is needed to determine why racial disparities in IVF outcomes persist.
More information
There's more on IVF at the U.S. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm ).
SOURCES: Eve Feinberg, M.D., assistant clinical professor, University of Chicago Medical Center, and physician, Fertility Centers of Illinois, Chicago; Lisa Carey Grossman, M.D., obstetrician-gynecologist, Columbia University Medical Center, New York City; Edward Illions, M.D., reproductive endocrinologist, Montefiore Medical Center, and associate professor, clinical obstetrics and gynecology and women's health, Montefiore Institute for Reproductive Medicine, Hartsdale, N.Y.; Oct. 22, 2014, presentation, American Society for Reproductive Medicine annual meeting, Honolulu
by Robert Preidt

Ebola Anxiety: A Bigger Threat Now Than the Virus Itself

Mental health experts offer antidotes to what they see as unnecessary worry on some Americans' part
TUESDAY, Oct. 21, 2014 (HealthDay News) -- Headlines remain riveted on the three Ebola cases in Dallas. But, mental health specialists say overblown fear is a much bigger health threat to Americans.
President Barack Obama on Friday appointed an Ebola "czar" to oversee the U.S. response to the virus, which has infected two Dallas nurses who cared for a Liberian man who died of Ebola this month at Texas Health Presbyterian Hospital.
But the U.S. cases are miniscule in the context of the Ebola outbreak in West Africa that's concentrated in Guinea, Liberia and Sierra Leone and has so far killed more than 4,500 people, according to the World Health Organization.
Still, U.S. mental health experts say the combination of a deadly infection, uncertainty about how the Dallas nurses contracted it and constant media coverage could set the stage for widespread public anxiety.
Americans aren't in panic mode yet, said James Halpern, director of the Institute for Disaster Mental Health at the State University of New York at New Paltz.
However, flu season is starting up, and its common symptoms -- fever, headache and muscle pain -- could be misinterpreted if people have Ebola on their minds.
"If we have a bad flu season, that could create a considerable emotional contagion," Halpern said.
"It's not only the virus that's contagious," he added.
In general, Halpern said, people have a hard time accurately assessing personal risk, and emotional reaction can override rational calculations. "We're more afraid of snakes than cigarettes," he noted.
And since most people, understandably, have limited knowledge of infectious diseases, they could be particularly susceptible to believing misinformation about disease outbreaks, said George Kapalka, a professor of psychological counseling at Monmouth University in West Long Beach, N.J.
Halpern agreed. With any worrisome event, he pointed out, "there's going to be a lot of misinformation and rumors going around." But faced with something as scary and unfamiliar as Ebola, people could have a particularly tough time separating reality from rumor, he said.
And then there's the media coverage. "I think there's been a gross overreaction on the part of the media," said Gerard Jacobs, director of the University of South Dakota's Disaster Mental Health Institute.
"The flu is a much greater threat to the American public than Ebola is," Jacobs said.
He suggested that if you are feeling anxious about Ebola, go to a reliable source for information, such as the U.S. Centers for Disease Control and Prevention. "Their focus is the health of the American public," Jacobs said. "They're scientists, not politicians."
Added Halpern: "Accurate information can be a good antidote to anxiety."
But once you find out some Ebola facts, find something else to do. It's not wise, Halpern said, to watch 24-hour news coverage of the outbreak, or devote hours of online time to it -- including social media sites, where rumors can run rampant.
That could be especially important advice for people already prone to anxiety, according to Kapalka. "Those individuals can have a more intense fear response to what they're hearing," he said. "It would be sensible for them to self-impose some limits on their media exposure."
According to the CDC, Ebola is spread through direct contact with the virus. "Direct contact" means that an infected person's bodily fluids -- such as blood, saliva or vomit -- have touched someone else's eyes, nose, mouth or broken skin.
Coughing and sneezing aren't common symptoms of Ebola, but the CDC says it's possible the virus could be transmitted if an infected person's saliva or mucus got into someone else's eyes, mouth or nose.
The bottom line, the CDC and other experts stress, is that you would need to be very close to someone with Ebola symptoms to become infected.
Kapalka suggested that, armed with that knowledge, people do a "reality check." That is, what are the chances you are going to be in close contact with someone likely to have Ebola?
Then, Kapalka said, "You might be able to tell yourself, my personal risk is so low, living in fear is not worth it."
More information
For more on coping with worry and stress, visit Anxiety and Depression Association of America (http://www.adaa.org/tips-manage-anxiety-and-stress ).
SOURCES: James Halpern, Ph.D., director, Institute for Disaster Mental Health, State University of New York, New Paltz; George Kapalka, Ph.D., professor, psychological counseling, Monmouth University, West Long Branch, N.J.; Gerard Jacobs, Ph.D., director, Disaster Mental Health Institute, University of South Dakota, Vermillion, S.D.
by Robert Preidt

Gene May Help Shield Hispanic Women From Breast Cancer, Study Says

Genetic variation also linked to less dense tissue
TUESDAY, Oct. 21, 2014 (HealthDay News) -- About one-fifth of Hispanic women have a genetic variation that offers significant protection against breast cancer risk, according to a new study.
The genetic variant originates from native Americans and reduces breast cancer risk by 40 percent to 80 percent, particularly the more aggressive estrogen receptor-negative forms of the disease, researchers said.
"The effect is quite significant," study senior author Dr. Elad Ziv, a professor of medicine at the University of California, San Francisco, said in a university news release.
"If you have one copy of this variant, which is the case for approximately 20 percent of U.S. Latinas, you are about 40 percent less likely to have breast cancer. If you have two copies, which occurs in approximately 1 percent of the U.S. Latina population, the reduction in risk is on the order of 80 percent," Ziv explained.
The researchers pinpointed the genetic variant after analyzing DNA from 3,140 breast cancer patients in the United States, Mexico and Columbia, as well as from nearly 8,200 women without breast cancer in those same countries.
The team also found that women with the genetic variant have breast tissue that appears less dense on mammograms. Breast tissue that appears more dense on a mammogram is a known risk factor for breast cancer, according to the study published Oct. 20 in the journal Nature Communications.
Hispanic women are at lower risk for breast cancer than women in other ethnic groups. Lifetime risk of the disease is 13 percent for whites, 11 percent for blacks, and less than 10 percent for Hispanics, according to the U.S. National Cancer Institute. The risk is even lower for Hispanic women with native American ancestry.
The newly identified genetic variant is on chromosome 6, near a gene that codes for an estrogen receptor called ESR1. Further research is needed to determine how the genetic variant affects breast cancer risk, the researchers said.
"If we can use these results to better understand how this protects [against] estrogen receptor-negative breast cancer, that would be interesting and important, because right now we have no good way to prevent that type of breast cancer," Ziv said.
More information
The American Cancer Society has more about breast cancer (http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-what-is-breast-cancer ).
SOURCE: University of California, San Francisco, news release, Oct. 20, 2014
by Robert Preidt

Health Highlights: Oct. 21, 2014

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:
Paralyzed Man Walks After New Type of Spinal Surgery
A 38-year-old Bulgarian man who was paralyzed from the waist down can walk again after groundbreaking surgery, and is believed to be the first person in the world to recover from complete severing of the spinal nerves.
Polish surgeons transplanted nerve-supporting cells from Darek Fidyka's nose to his spinal cord in order to help the ends of severed spinal nerve fibers to grow and rejoin, something previously thought to be impossible, reported The Guardian newspaper in the U.K.
The successful surgery on Fidyka, who was paralyzed four years ago, offers hope to the millions of spinal cord injury patients around the world.
"We believe that this procedure is the breakthrough which, as it is further developed, will result in a historic change in the currently hopeless outlook for people disabled by spinal cord injury," Geoffrey Raisman, leader of the team at University College London's institute of neurology that developed the treatment, told The Guardian.
"The patient is now able to move around the hips and on the left side he's experienced considerable recovery of the leg muscles," Raisman said. "He can get around with a walker and he's been able to resume much of his original life, including driving a car. He's not dancing, but he's absolutely delighted."
If funding can be raised, at least three more patients will undergo the procedure in Poland over the next three to five years, Raisman said.
The research was funded by the U.K. Stem Cell Foundation and the Nicholls Spinal Injury Foundation (NSIF), and the details of the treatment will be shared with experts worldwide.
"The scientific information relating to this significant advancement will be made available to other researchers around the world so that together we can fight to finally find a cure for this condition which robs people of their lives," NSIF founder David Nicholls told The Guardian.
Millions of U.S. Car Owners Urged to Get Air Bag Defect Repaired
More than 4.7 million people in the United States need to get the air bags in their cars fixed immediately to correct a defect that could injure or kill the driver or passengers, the National Highway Traffic and Safety Administration says.
The inflator mechanisms in the air bags can rupture and release a shower of metal fragments when the bags are deployed in crashes. The defect has caused at least four deaths and there have been many injuries, according to safety advocates, the Associated Press reported.
Worldwide, about 12 million vehicles have been recalled due to the problem with the air bags made by Takata Corp. of Japan. The defective air bags were used in vehicles made by BMW, Ford, General Motors, Honda, Mazda, Nissan, and Toyota.
The NHTSA began investigating the problem in June and has cited six cases of air bag inflator ruptures that resulted in three injuries. Safety advocates say the air bag defect could affect more than 20 million vehicles in the U.S., the AP reported.
Ban Most Edible Marijuana Products: Colorado Health Officials
Edible forms of marijuana such as brownies, cookies, and candies should be banned, Colorado health officials say.
In a submission to state marijuana regulators, the Department of Public Health and Environment says these edible marijuana products "are naturally attractive to children" and violate the state law's "requirement to prevent the marketing of marijuana products to children," the Associated Press reported.
Edible marijuana products should be restricted to lozenges and some liquids, the health department said in recommendations sent to regulators Oct. 14.
The final decision on the issue will be made by the Department of Revenue's Marijuana Enforcement Division. If it agrees with the health department, most types of edible marijuana would no longer be available in stores, the AP reported.
The state's marijuana regulators received several submissions about edible marijuana products. An advocacy group called Smart Colorado wants the products to be colored, marked or stamped to indicate they contain the drug.
The marijuana industry opposes attempts to ban many of the edible marijuana products currently available in Colorado, the AP reported.
by Robert Preidt

Research Shows No Link Between Vaccinations, Risk for Multiple Sclerosis

Large study finds no association, although certain shots might speed onset of existing illness
TUESDAY, Oct. 21, 2014 (HealthDay News) -- A new study finds no link between vaccines and increased risk of multiple sclerosis or similar nervous system diseases.
Even though some have questioned whether vaccines -- particularly for hepatitis B and human papillomavirus (HPV) -- might be associated with a small rise in the risk of MS, prior studies yielded mixed findings on the issue, with most studies showing no link.
Many of those studies were limited by small numbers of participants and other factors, said the new team of researchers led by Dr. Annette Langer-Gould of Kaiser Permanente, Southern California, and colleagues.
In their new research, Langer-Gould's team analyzed data from 780 patients with MS or related diseases and compared their vaccination histories with that of more than 3,800 healthy patients. The participants included females aged 9 to 26, which is the indicated age range for HPV vaccination.
The researchers found no link between any vaccine -- including for hepatitis B and HPV -- and an increased risk of MS or related diseases for up to three years after vaccination, according to the study published online Oct. 20 in the journal JAMA Neurology.
Among patients younger than 50, there was an increased risk of the onset of MS and related diseases in the first 30 days after vaccination, but that association vanished after 30 days, the researchers found. That suggests that vaccination may accelerate the onset of symptoms in people who already have MS or related diseases but have not experienced any symptoms.
"Our data do not support a causal link between current vaccines and the risk of MS or [related diseases]. Our findings do not warrant any change in vaccine policy," the study authors wrote.
One expert in multiple sclerosis believes the study results are reassuring.
"While lingering questions about the safety of any vaccine continue to arise among the general public -- and especially among MS patients -- this well-executed study confirms what we already believe," said Dr. Karen Blitz, director of the North Shore-LIJ Multiple Sclerosis Center in East Meadow, N.Y.
"The general opinion [among experts] has always been that MS patients should receive flu shots, and now the data supports them receiving vaccinations for hepatitis B and HPV as well," she added.
"The only special consideration regarding vaccines that MS specialists recommend is that MS patients taking certain immunosuppressive drugs or disease-modifying therapies should stay away from vaccines containing 'live attenuated viruses,' such as the nasal mist vaccine for influenza," Blitz said.
More information
The American Academy of Family Physicians has more about multiple sclerosis (http://familydoctor.org/familydoctor/en/diseases-conditions/multiple-sclerosis.printerview.all.html ).
SOURCES: Karen Blitz, D.O., director, North Shore-LIJ Multiple Sclerosis Center, East Meadow, N.Y.; JAMA Neurology, news release, Oct. 20, 2014
by Robert Preidt

Ebola or Not? Rapid Test for the Virus Not Here Yet

With flu season approaching, finding an accurate, speedy screening method will become more important
MONDAY, Oct. 20, 2014 (HealthDay News) -- "Diagnosing Ebola is very different from treating Ebola."
That assessment, by Dr. Daniel Varga, chief clinical officer at Texas Health Resources, during testimony before a Congressional panel on Thursday, sums up the critical concern at the heart of the current Ebola scare.
It was the challenge faced by staff at Texas Health Presbyterian Hospital in Dallas as they struggled in late September to identify and manage the case of Thomas Eric Duncan, the first patient ever diagnosed with Ebola on American soil. Duncan, a Liberian national, died of the disease on Oct. 8.
The problem: the absence of an accurate, rapid test for Ebola, even in the disease's symptomatic stages.
Varga, who oversees Texas Health Presbyterian Hospital, believes the hospital was "well prepared and equipped" to care for a patient diagnosed with Ebola. "Where we fell short initially was in our ability to detect and diagnose" the infection, he testified.
Complicating matters is the fact that the initial symptoms of Ebola -- high fever, headache, diarrhea, vomiting -- can seem much like those of other infectious diseases, including influenza. And with another U.S. flu season set to begin, how will worried Americans quickly know if they have that common bug -- or Ebola?
A test that can tell the difference in minutes or even a few hours just isn't available right now, experts say.
First of all, there is no test at all to determine Ebola infection in a person without symptoms.
"Ebola has an incubation period of from two to 21 days, and nothing we have is effective at picking up infection before that happens," explained Philip Tierno, a clinical professor of microbiology and pathology at NYU Langone Medical Center in New York City.
"In fact, pre-symptomatic diagnosis is really a holy grail for infectious disease," added Dr. Amesh Adalja, a spokesman for the Infectious Disease Society of America. "It would be great to have it for Ebola and influenza, and a whole host of other infectious diseases, so we could intervene fast. And it's certainly something that many people are researching. But that kind of screening ability is really still in its infancy."
But what about after symptoms begin to appear, as in Duncan's case? Again, no speedy test for Ebola yet exists.
That means that "it's going to be very difficult to distinguish influenza from Ebola," Adalja said.
"Right now," Tierno added, "there's just no simple, fast Ebola test because there's been no demand. Until now, nobody has wanted to spend the money to get a commercially available rapid test out there."
He said that "what we do have on hand is the PCR (polymerase chain reaction) test," a DNA analysis that can identify the genetic fingerprints for a host of infectious diseases. This is the type of laboratory test that's been used to diagnose symptomatic Ebola cases so far.
The catch: The PCR test typically takes at least 24 hours to bring back results, Tierno noted.
That could change due to emerging technology, however.
"Much more rapid diagnostic tests for other infectious diseases such as influenza, mono [mononucleosis] or group A strep do exist," Adalja said. "And there is a new technology, made by a company called BioFire, that does do very rapid PCR testing, which for influenza gives results in an hour. It's a real breakthrough. But it will only work with patients who already have symptoms, and it has only gotten FDA approval for respiratory infections -- not for Ebola."
Adalja believes that "the fact that this rapid test works for influenza argues that it would work for Ebola as well. There's no reason it wouldn't."
So, is FDA approval for a similar, quick screen for symptomatic Ebola in the offing?
"I certainly think the FDA will now have to fast-track it for approval," said Tierno. "But then the big problem becomes who's going to pay for this? It's not going to be cheap -- it's probably $150 a shot. And with the kind of hysteria we have already, anyone with sniffles is going to demand this analysis."
In the meantime, factors other than a blood test may be the public's best defense in quickly spotting Ebola, the experts said.
"The 'big screen', so to speak, has to be travel history," Adalja said. "Right now Ebola is only present in three countries in West Africa. So if a patient with symptoms has been to this region in the last 21 days, or has had contact with anyone else who has been or has a confirmed case, than Ebola may be higher on the list of concerns."
Added Tierno: "Based on that, a patient is flagged for risk [and] then he would be quarantined immediately. Before any testing -- placed in an isolation unit. And then, I would say, first tested for influenza, and then perhaps a panel of 22 or 23 other respiratory organisms as a second step. Only when all else is ruled out should we test for Ebola."
Both Tierno and Adalja stressed, however, that in the vast majority of cases, symptoms will not turn out to be due to Ebola.
Right now, "the risk that someone [in the United States] who doesn't fit the travel profile will actually contract Ebola is infinitesimally small," said Tierno. "It's basically non-existent."
And Adalja said there's one more clue that the lousy way you're feeling is probably flu, not Ebola.
"Ebola is primarily not a respiratory disease. So it doesn't necessarily cause a runny nose, or congestion or sneezing," all standard flu symptoms, he said. "Only one-third of people with Ebola will cough, whereas that is much more prevalent with the flu."
More information
For more on Ebola, head to the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/vhf/ebola/ ).
SOURCES: Amesh Adalja, M.D., representative and member, Infectious Disease Society of America's public health committee, Arlington, Va.; Philip Tierno, Ph.D, clinical professor, microbiology and pathology, department of pathology and department of mircobiology, NYU Langone Medical Center, New York City
by Robert Preidt

Man Treated for Ebola in Atlanta Now 'Free' of the Virus

Unidentified patient arrived at Emory University Hospital Sept. 9, was discharged Sunday, officials say
MONDAY, Oct. 20, 2014 (HealthDay News) -- An unidentified patient being treated at Emory University Hospital in Atlanta is now "free of Ebola virus disease" and was discharged Sunday from the facility, the medical center said in a statement released Monday afternoon.
The man, who has requested anonymity since being admitted to care at Emory's Serious Communicable Disease Unit on Sept. 9, now poses no threat to public health and has left the hospital for an "undisclosed location," the hospital added.
Emory had previously successfully treated two medical missionaries who became infected in West Africa, the site of the worst Ebola outbreak in history.
Also Monday, the American video journalist infected with Ebola while working in Liberia is improving and could be released from the hospital by week's end, doctors at Nebraska Medical Center in Omaha said. Ashoka Mukpo, of Providence, R.I., has been undergoing treatment at the hospital since Oct. 6.
The dual announcements followed more good news on the Ebola front in the United States: Dozens of people who had contact with the Dallas patient who died earlier this month are no longer in danger of catching the disease, health officials said Monday.
Those people include the fiancee and other family members of Thomas Eric Duncan, the Liberian native who contracted the disease in his home country before arriving in Dallas last month.
Also cleared were the paramedics who drove Duncan to Texas Health Presbyterian Hospital on Sept. 28 and health care workers who drew or processed his blood. And a mandatory quarantine was lifted for a homeless man who later rode in the same ambulance as Duncan before it was disinfected, The New York Times reported.
All told, the 21-day monitoring period ended Sunday and Monday for roughly 50 people, the newspaper reported.
An estimated 120 people remain under watch because they could have had contact with one of the three people in Dallas who came down with the disease. Besides Duncan, the other two include two nurses who treated him at Texas Health Presbyterian Hospital.
Federal health officials have said that symptoms of Ebola show up within 21 days of exposure to the virus.
In other developments:
Nigeria, Africa's most populous country with 160 million people, has been declared free of Ebola. Officials attributed aggressive health care measures that led to just 20 cases of infection and eight deaths. Leaders of the European Union have set a goal of nearly $1.3 billion in aid to help combat the Ebola outbreak in West Africa.
Meanwhile, U.S. health officials on Monday tightened guidelines for health care workers who are treating Ebola patients.
The new recommendations call for full-body suits and hoods with no skin exposure and use of a respirator at all times. There will also be stricter rules for removing equipment and disinfecting hands, and the designation of a "site manager" to supervise the putting on and taking off of equipment used while treating a patient.
The revised guidelines are apparently in response to the two nurses in Dallas who became infected with Ebola while treating Duncan, the first diagnosed case of the disease in the United States.
Health officials aren't sure how the nurses became infected with the often deadly disease, which has decimated three West African nations since last spring.
But Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said Sunday that the nurses caring for Duncan had some of their skin exposed, the AP reported.
"Very clearly, when you go into a hospital, have to intubate somebody, have all of the body fluids, you've got to be completely covered. So, that's going to be one of the things," the news service quoted Fauci as saying.
Also Sunday, U.S. Defense Secretary Chuck Hagel announced the creation of a 30-member team of military personnel to help civilian medical professionals in the United States if its assistance is needed to treat Ebola. The team will include doctors, nurses and infectious disease experts, the AP reported.
To date, there have been three cases of Ebola diagnosed in the United States: the two nurses and Duncan.
Early Sunday morning, a cruise ship carrying a lab worker who was being monitored for Ebola because she'd handled a lab specimen from Duncan returned to its port in Galveston, Texas, cruise line officials said.
The unidentified woman is a laboratory manager at Texas Health Presbyterian. She had been voluntarily quarantined aboard the Carnival ship with her husband. She was showing no signs of symptoms of the disease and posed no risk because she has been symptomless for 19 days, federal officials said, according to the AP.
Carnival Cruise Lines said it had been told by health officials Sunday morning that the lab worker tested negative for Ebola, the news service said.
And Spanish health authorities reported Sunday that a nurse's aide who had become infected with Ebola while caring for an elderly priest was free of the virus.
On Saturday, President Barack Obama called on Americans not to give in to panic over Ebola. And he repeated his opposition to a travel ban for flights from the three affected countries in West Africa -- Guinea, Liberia and Sierra Leone.
In his weekly radio and Internet address, Obama said Ebola "is a serious disease, but we can't give in to hysteria or fear -- because that only makes it harder to get people the accurate information they need. We have to be guided by the science."
Some lawmakers have called for a travel ban, but Obama believes such a move would be counterproductive. "Trying to seal off an entire region of the world -- if that were even possible -- could actually make the situation worse," he said.
The Ebola outbreak in West Africa has killed nearly 4,500 people out of an estimated 9,000 reported cases, according to the World Health Organization.
More information
For more on Ebola, visit the World Health Organization (http://www.who.int/csr/disease/ebola/en/ ).
SOURCES: Oct. 20, 2014, statement, Emory Health Sciences; Oct. 18, 2014, White House weekly address; Oct. 16, 2014, hearing, House of Representatives' House Energy and Commerce Subcommittee on Oversight and Investigations; The New York Times; Associated Press

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